Upper GI Surgery

Question 1

What conditions are treated with upper GI surgery?

Answer 1

Oesophageal cancer
Gastric cancer
Anti-reflux
Bariatric surgery

Question 2

Is oesophageal cancer more common in m or F?

Answer 2

M

Question 3

What is the median age for oesophageal cancer?

Answer 3

65

Question 4

In Oesophageal cancer where are adenocarcinomas more likely to occur?

Answer 4

Distally

Question 5

What are the main risk factors for squamous cell carcinoma in the oesophagus?

Answer 5

Smoking
Alcohol
Low socio-economic status

Question 6

What are the symptoms for oesophageal cancer?

Answer 6

Progressive dysphagia 
Anorexia and weight loss 
Odynophagia 
chest pain/heart bur n
Haematemesis

Question 7

What investigations can diagnose oesophageal cancer?

Answer 7

Endoscopy

Contrast swallowing

Question 8

What investigations need to be done t stage oesophageal cancer?

Answer 8

CT of Chest and Abdomen

Question 9

What classification is used to stage oesophageal cancer?

Answer 9

TNM

Question 10

If metastases are found is any further staging required?

Answer 10

No

Question 11

What is the treatment for metastasised oesophageal cancer?

Answer 11

Palliative and supportive therapy

Question 12

What treatment can be given to relieve symptoms present in oesophageal cancer?

Answer 12

Stenting

Question 13

When is a patient suitable for resection in oesophageal cancer?

Answer 13

If no metastases are found and the cancer is primary

Question 14

What is the treatment for primary oesophageal cancer?

Answer 14

Oesophagectomy and chemo

Question 15

What is an oesophagectomy?

Answer 15

Removal of part of the oesophagus

Question 16

What is inserted after a patient undergoes a oesophagectomy?

Answer 16

feeding tube

Question 17

Anatomically where does an oesophacetomy require access to?

Answer 17

Above and below the diaphragm

Question 18

Is gastric cancer more common in M or F?

Answer 18

M

Question 19

Which bacteria is gastric cancer often associated with?

Answer 19

H.pylori

Question 20

What is the 5yr survival rate of gastric cancer?

Answer 20

15-20%

Question 21

What are the symptoms of gastric cancer?

Answer 21

Non-specific often 
Dyspepsia 
Dysphagia 
Evidence of GI blood loss
Weight loss 
Vomiting 
Upper abdominal mass on examination

Question 22

What investigations are used to diagnose gastric cancer?

Answer 22

Endoscopy

Contrast meal

Question 23

What investigations are used to stage gastric cancer?

Answer 23

CT chest and abdo

Question 24

What treatment is given before gastric cancer surgery is attempted/

Answer 24

Chemotherapy

Question 25

Why is chemotherapy given before gastric cancer surgery?

Answer 25

To shrink the tumour and catch any micrometastases

Question 26

What is a subtotal gastrectomy?

Answer 26

Removal of part of the stomach

Question 27

What is a total gastrectomy?

Answer 27

Removal of the entire stomach

Question 28

What are the two methods for gastrectomy surgery?

Answer 28

Laparoscopically | Or open surgery

Question 29

Describe the scar in gastric surgery?

Answer 29

Downwards V

Question 30

Why is the scar V shaped with gastric surgery?

Answer 30

To stop and overload of pressure of the abdomen wall

Question 31

What is GORD?

Answer 31

Gastro-oesophageal Reflux Disease

Question 32

What are the symptoms of GORD?

Answer 32

Heartburn Water brash Cough

Question 33

What are the risk factors for GORD?

Answer 33

Obesity Smoking Alcohol

Question 34

Describe oesophageal pH studies as an investigation

Answer 34

pH of the stomach is recorded Along with the patient keeping a diary of their daily symptoms Assessing to see if there is any correlation between the two

Question 35

What are the classifications of obesity?

Answer 35

Overweight Obesity I Obesity II Obesity III

Question 36

What is the BMI of someone overweight?

Answer 36

25.0-29.9

Question 37

What is the BMI of someone with Obesity I?

Answer 37

30.0-34.9

Question 38

What is the BMI of someone with Obesity II?

Answer 38

35.0-39.9

Question 39

What is the BMI of someone with Obesity III?

Answer 39

>40.0

Question 40

Give examples of conditions that obesity is a risk factor for?

Answer 40

``` Pulmonary disease Hypertension Cancer Pancreatitis Gout Osteoarthritis Fatty liver disease CHD Stroke Cataracts ```

Question 41

What is restrictive bariatric surgery?

Answer 41

When the size of the stomach is decreased

Question 42

What is malabsorptive bariatric surgery?

Answer 42

When segments of the bowel are bypassed

Question 43

What is combination bariatric surgery?

Answer 43

A mixture of restrictive and malabsorptive bariatric surgery

Question 44

What needs to be taken into consideration with bariatric surgery?

Answer 44

``` Patients choice Safety Surgeons choice Personal Patients BMI and co-morbidities ```

Question 45

What are the Pros of restrictive bariatric surgery?

Answer 45

Relatively minor surgery Reversible and adjustable Low operative complication rate Low mortaility

Question 46

What are the cons of restrictive bariatric surgery?

Answer 46

Required an implanted device Easier to cheat Risk of prolapse of slippage of the band

Question 47

What are the pros of malabsorptive bariatric surgery?

Answer 47

Quick and dramatic weight loss Pedigree Dumping syndrome

Question 48

What are the cons of malabsorptive bariatric surgery?

Answer 48

More invasive Require lifelong supplements More complex if require revision Slight mortality rate

Question 49

What are the pros of combination bariatric surgery?

Answer 49

Good medium of surgery No dumping syndrome No small bowel manipulation No foreigns body is implanted

Question 50

What are the cons of combination bariatric surgery?

Answer 50

More invasive Long staple line Short pedigree Small mortality rate

Question 51

What are the complications of any bariatric surgery?

Answer 51

``` Anastomotic leak DVT/PE Infection Malnutrition Vitamin and mineral deficiencies Hair loss Excess skin ```